Wall Acetabular Fractures Research Articles

A preliminary study of three-dimensional printed porous titanium plate integrated implant for the repair of comminuted acetabular posterior wall fracture with bone defect

To explore the feasibility of using computer-aided design(CAD) combined with 3D printing technology to repair and reconstruct the comminuted fracture of the posterior wall of acetabulum with osteochondral defect, to evaluate the biomechanical properties of composite titanium nitride bioceramic coatings with porous titanium alloy scaffolds and steel plate integrated implants. Based on CT images of continuous tomography, the computer-aided design software was used to construct a digital model of porous titanium alloy plate implant with a specially open cellular three-dimensional structure, and the three-dimensional implant was prepared with Ti6Vl4V powder by using the 3D printing technology, following by titanium nitride coating on its articular surface. The degree of matching and attachment between the implant and acetabulum were observed; Ansys software was used for finite element modeling to analyze the stress distribution, stress conduction and deformation displacement of the acetabulum of the normal group, the traditional group and the implant group under the same load state, and to verify the biomechanical properties of the implant. The porous titanium alloy implant fit well with the acetabular bone defects, the shape of the plate was well attached to the bone surface, and it was rated as excellent according to the Matta criteria. The Von Mises stress peak of the implant group 13.38 MPa was close to the normal group 13.11 MPa and smaller than that in the traditional group 15.66 MPa. The Von Mises stress distribution and conduction of implant group were basically consistent with the normal group, slightly better than the traditional group; the maximum relative displacement of the implant was 0.166 mm, according to the finite element analysis. The porous titanium alloy stent plate implant with titanium nitride coating prepared by 3D technology has excellent matching degree and biomechanical properties; the anatomical reconstruction makes the stress distribution and conduction recovery well, close to normal hip joints, which provides a new option for the clinical treatment of comminuted posterior acetabular wall fractures with severe bone defects.

An Unusual Presentation of Pubic-type Anterior Hip Dislocation with Concomitant Anterior and Posterior Acetabular Wall Fracture

Anterior hip dislocation is uncommon, comprising only 5%-15% of hip dislocations. It usually occurs following a severe external rotation and abduction injury. These injuries are occasionally associated with acetabular fractures, which generally occur in the direction of dislocation. We describe a rare case of pubic-type anterior hip dislocation with concomitant anterior and posterior acetabular wall fractures in a young male following a road traffic accident. The dislocation could not be reduced by closed means and open reduction had to be performed. Reduction of the hip allowed the wall fragments to fall back to their place and the hip remained stable. At the one-year follow-up, the clinical and radiological results were excellent. This case also emphasizes the importance of early diagnosis and prompt reduction in the successful management of these types of injury.

Crescent Technique with Dual C-Shaped Reconstruction Plates for Posterior Acetabular Wall Fractures

Background: Here we have defined a novel technique for repairing posterior acetabular wall fractures called the “crescent technique,” in which dual C-shaped reconstruction plates overlap at the distal ends and, if necessary, at the proximal ends. We also analyzed the efficacy and reliability of this method. Patients and Methods: This was a retrospective analysis of 27 patients undergoing the crescent technique. All of the fractures were treated by the senior author for a mean of 7.9 days (0–15 days) after the trauma. The mean follow-up period was 19 months (13–29 months). The clinical results were evaluated using the modified clinical grading system developed by Merle d’Aubigne and Postel, and then modified by Matta. The radiographs were graded according to the criteria described by Matta. Results: In the clinical grading, 16 (59%) of the patients were excellent and very good, 5 (19%) were good, 3 (11%) were moderate, and 3 (11%) were poor. According to the Matta radiological evaluation criteria, 19 (70%) were excellent, 4 (15%) were good, 4 (15%) were fair, and none were poor. Statistically significant consistency was seen between the clinical and radiological results (p = 0.002). Conclusions: The crescent technique is a dual plate technique modification that can provide a stable fixation. It appears to be an effective and reliable method for treating posterior wall fractures of the acetabulum.

Progress in treatment and research of acetabular posterior wall fracture

Fracture of the posterior wall is the most common type of acetabular fractures, but it is often associated with such injuries as dislocation of hip joint, femoral head fracture and lesion of sciatic nerve. Latest researches have found that treatments of fracture of the acetabular posterior wall often lead to unsatisfactory outcomes because its prognosis is influenced by a variety of factors, including its associated injuries, subtypes, and quality and timing of surgical reduction. This review summarizes extensive clinical experiences in treatment of the fracture and available literature concerning management and research of the fracture so as to provide enough information for junior surgeons to have a better understanding of the fracture and its treatment, improving the prognosis of the fracture and effectively avoiding the pitfalls in their clinical practice. Key words: Acetabularum; Therapy; Complications; Posterior wall fracture; Assessment

Management of acetabular wall fractures with hip dislocation: A case series

Introduction: Posterior wall fractures are the most common type of acetabular fractures. Comminuted fractures with extensions to acetabular roof are associated with poor prognosis. Accurate evaluation of resuting union and likelihood of future arthritis or AVN of femoral head are also hindered. Materials and methods: We report a case series of 9 cases with posterior wall acetabulum fractures associated with posterior dislocation of femoral head treated with internal fixation of posterior wall by three step reonstruction-1)open reduction of dislocation, 2)preservation of soft tissues and reconstruction of marginally impacted and osteochondral fragments using screws, 3)final reinforcement with buttress plating. Functional outcome was evaluated according to D’aubigne and Postel criteria and radiological outcome by criteria of Matta. Results: According to criteria of Matta 44% had excellent, 34% had good and 22% had fair results. According to D’aubigne and Postel criteria 50% had excellent results, 37.5% had good results, 12.5 % had fair results. None of the cases had heterotrophic ossification. Wound site infection eas the only complication encountered. Conclusion: We conclude that this three step rconstruction procedure in management of posterior wall acetabular fracture with posterior dislocation of femoral head results in satisfactory functional and radiological outcome without complications.

Risk factors and treatment of intraoperative periprosthetic acetabular fracture during total hip arthroplasty

Objective To analyze the risk factors of periprosthetic acetabular fracture in total hip arthroplasty (THA) and to discuss the prevention and management. Methods A total of 1 023 patients (1 168 hips) undergoing THA were retrospectively analyzed between January 2012 and June 2015. There were 421 males (507 hips) and 602 females (661 hips), aged from 23 to 96 years with mean age of 64.2±15.0 years. Primary total hip arthroplasty was conducted in 1 053 hips, while revision surgery was conducted in 115 hips. The reasons of periprosthetic acetabular fracture were summarized. Age, gender, BMI, primary disease, left or right sides, surgical approach, osteoporosis, prosthetic type, the coverage rate of acetabulum-bone, and the amount of surgical operation annually were compared between non-fracture and fracture. Risk factors associated with the fracture were analyzed using chi square test followed by a multivariate logistic regression. Furthermore, revision surgery was compared with primary THA using chi square test. Results The incidence of intraoperative periprosthetic acetabular fractures was 2.8% (33/1 168). The incidence of fracture was higher in revision surgery than that in primary THA (6.1% vs. 2.5%). Multivariate logistic regression showed that primary disease (developmental dysplasia of the hip and rheumatoid arthritis), osteoporosis, uncemented acetabular cup, the higher coverage rate of acetabulum-bone, and the less amount of surgical operation annually were prone to appear periprosthetic acetabular fracture in primary THA. Among the 33 patients with acetabular fractures, 13 cases (39.4%, 13/33) were found intraoperatively and 20 cases (60.6%, 20/33) postoperatively. Acetabular wall fractures were in 26 (78.8%, 26/33), column fractures in 2 (6.1%, 2/33), transverse fractures in 2 (6.1%, 2/33) and quadrilateral surface fractures with prosthetic central dislocation in 3 (9.1%, 3/33). Seven cases of 26 stable fractures and 6 cases of 7 unstable fractures were found intraoperatively. Acetabular wall fractures were fixed by additional augmentation screws or accepted no special treatment, and column fractures were fixed with plate. One quadrilateral surface fracture was accepted revision surgery using Jumbo cup, 2 quadrilateral surface fractures and 2 transverse fractures with reconstruction cage. The patients were followed up for 42.3±13.7 months (range 29-60 months). The Harris hip score was 83.3±6.6 (range 72-94) at last follow-up. No complication, such as hip dislocation, osteolysis, and prosthetic loosening was reported. Conclusion Most of periprosthetic acetabular fractures are wall fractures which could not endanger the periprosthetic stability. The detection rate of acetabular stable fracture is lower than that of unstable fracture in operation. Primary disease (developmental dysplasia of the hip and rheumatoid arthritis), osteoporosis, uncemented acetabular cup, the higher coverage rate of acetabulum-bone, the less amount of surgical operation annually are the intraoperative risk factors which closely related to acetabular fractures of primary THA. The risk of intraoperative periprosthetic acetabular fractures in revision THA is higher than that in primary THA. Key words: Arthroplasty, replacement, hip; Acetabulum; Fractures, bone; Risk factors

Neglected posterior acetabular wall fracture managed with uncemented total hip arthroplasty with posterior wall reconstruction by femoral head autograft: a case report

<p class="abstract">Total hip arthroplasty (THA) poses several challenges as a treatment option for acetabular fracture especially in the setting of a neglected fracture. The potential technical challenges of THA include the altered anatomy and hip centre, acetabular bone deficit, difficulty in achieving long-term fixation of the acetabular shell and risk of nerve injury. In our case, a forty two years old, male labrourer presented with a five months old injury, which was previously managed only conservatively. Preoperative evaluation revealed displaced posterior wall acetabulum with superiorly migrated femur head with flattened contour. We managed the case with uncemented THA. The acetabular defect was addressed using the femoral head autograft which was secured with screws. On three months follow up, radiographical evalution showed good graft consolidation without any acetabular component migration and functionally a Harris hip score of 76. Thus, in case of neglected acetabular fractures, with high probability of post traumatic arthritis to develop, THA remains the preferred choice of management. Albeit challenging to perform, THA provides effective way to decrease pain, improve stability and increase functional outcomes<strong>.</strong></p>

Instability of the Hip Joint After Posterior Acetabular Wall Fracture: Independent Risk Factors Remain Elusive.

Exact determinants of hip instability have not been established for fractures of the posterior wall of the acetabulum involving ≤50% of the wall. Therefore, examination of the hip under anesthesia (EUA) is routinely performed. Recently, the superior exit point of the fracture has been reported to be an important identifiable risk factor. Pre-existing adult hip dysplasia (developmental dysplasia of the hip [DDH]) is thought to have a similar role. The purpose of this study was to determine if any known radiographic measurements and signs associated with DDH, or any fracture characteristics, are independent risk factors for hip instability after fracture of the posterior wall of the acetabulum. All patients with a posterior acetabular wall fracture (OTA 62.A1) treated at our institution between 2004 and 2015 were considered for the study. Inclusion criteria were an age of ≥18 years, an isolated posterior acetabular wall fracture involving ≤50% of the acetabular wall, adequate imaging, and documented EUA results. Evaluated variables included fracture fragment size, superior exit point of the fracture, center-edge angle, acetabular index, Tönnis angle, lateralized head sign, crossover sign, posterior wall sign, ischial spine sign, and hip version. Data were examined using univariate testing, followed by a multivariate logistic regression analysis. Sixty-eight patients met all of the inclusion criteria. Univariate analyses identified the posterior wall sign (p = 0.033), ischial spine sign (p = 0.030), and proximity of the superior exit point of the fracture to the acetabular dome (p = 0.044) as having a significant association with hip instability. However, multivariate logistic regression modeling revealed that none of these factors were significant independent risk factors. Consistent with previous studies, univariate analyses identified certain radiographic findings as significant risk factors for hip instability in the setting of a fracture of the posterior wall of the acetabulum. However, subsequent multivariate logistic regression modeling showed that no studied variable was an independent risk factor. Our results indicate that important factors leading to hip instability are yet to be identified or the contributions of the measured variables are relatively small. Therefore, EUA should remain the main clinical determinant of hip stability status. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Surgical Treatment of Unstable Posterior Wall Acetabular Fractures

: Acetabular fractures are severe injuries, generally caused by high-energy trauma, most frequently from traffic accidents or falls from heights. Fractures of the extremities, head, chest, abdomen and pelvic ring injuries are most commonly associated injuries. Aim: To evaluate the results of surgical treatment of unstable posterior wall fractures with open reduction and internal fixation. Patients and Methods: In this study, 16 patients with unstable posterior wall acetabular fractures. As regard age of the patients, it ranged from 20- 60 years with mean 32.8±9.12 years. They were 12 males and 4 females. The cause of trauma was road traffic accident (RTA) in all patients. All patients were operated upon with open reduction and internal fixation using reconstruction plates and cancellous screws for treatment posterior acetabular fracture in the period from March 2014 to March 2016 with follow up period ranging from 2 months to 2 years. Results: Satisfactory functional outcome was obtained in 12 cases, excellent in 5 and good in 7 cases, while unsatisfactory functional outcome was obtained in 4 cases, fair in 3 and poor in one. Conclusions: Open reduction and internal fixation is an effective method for treatment of unstable posterior acetabular wall fractures. Surgical treatment leads to early rehabilitation and avoiding complications as osteoarthritis

Long-term follow-up study of Kocher-Langenbech approach for treatment of delayed acetebular posterior wall fractures

Objective To evaluate the long-term follow-up results of surgical treatment of delayed acetebular posterior wall fractures via the Kocher-Langenbech (K-L) approach. Methods A retrospective review was made on 22 patients with delayed acetabular posterior wall fractures treated surgically via the K-L approach from April 2001 to December 2010. Patient follow-up data was complete. The patients consisting of 16 males and 6 females showed an age of (34.1±8.9)years (range, 25-43 years). Causes of injury were traffic accidents in 18 patients and high falls in four patients. There were 14 patients accompanied with brain injuries, eight thorax-abdominal injuries and 12 other extremity injuries. Sciatic nerve paralysis was found in five patients preoperatively. Time interval from injury to surgery was (44.7±9.7)d (range, 27-182 d). Fracture reduction was evaluated using the Matta standard and hip function using the modified Merle D’Aubingne and Postel scoring system. Postoperative complications were detected. Results Period of follow-up was(102.1±11.3)months. According to the Matta standard, fracture reduction was anatomic in 16 patients, unsatisfactory in four and poor in two. According to the modified Merle D’Aubingne and Postel scoring system, the results were excellent in 15 patients, good in four, fair in two and poor in one, with the excellent-good rate of 86%. Heterotopic ossification developed in three patients (14%) and temporary paralysis of sciatic nerve in two patients (9%). Fourteen patients were found with slight stenosis of the articular space but there was no degeneration. Five patients were found with stenosis of the articular space as well as slight degeneration. Three were complicated with trauma arthritis, among which one had total hip arthroplasty after 3 years. Conclusions Delayed acetebular posterior wall fractures can be extensively exposed via the K-L approach and the congruity of the acetebular posterior wall can be restored after appropriate open reduction and internal fixation. Long-term follow-up study indicates satisfactory clinical results. Key words: Acetabulum; Hip injuries; Fracture fixation, internal

Pearls: How to Reduce and Fix Comminuted Posterior Acetabular Wall Fractures.

Pearls: How to Reduce and Fix Comminuted Posterior Acetabular Wall Fractures.

English

English

Combined approach to treatment of Tile type B and C old pelvis fracture

Objective To investigate the operative methods in treatment of Tile type B and C old pelvis fracture. Methods The study enrolled 19 cases (13 males and 6 females) with a mean age of 53.4 years (range, 25-66 years) treated from July 2009 to July 2014. Injury resulted from traffic accidents in 14 cases, high falls in 3 cases and hit by heavy objects in 2 cases. Time from injury to operation was 1.5-10.3 months. According to the Tile classification, the type of fracture was 5 B2, 5 B3, 3 C1, 4 C2 and 2 C3. Four cases of type B and two cases of type C were combined with acetabulum fracture. Type B fracture deformity was operated through the anterior letournel approach, during which the malunion had osteotomy and reconstruction plate fixation. When posterior wall or column acetabular fracture existed, additional posterior Kocher-Langenbeck incision was used to achieve fracture reduction and stabilization through bilateral fenestration in the floating position. Type C fracture undergone osteotomy through anterior letournel approach and posterior sacral osteotomy or ilio-lumbar fixation following sacroiliac osteotomy. With regard to the combined posterior wall or column acetabular fracture in type C fracture, the surgical method was the same as type B. Radiological and functional results were respectively evaluated using the Mears-Velyvis system and Majeed criteria. Results Mean duration of follow-up was 11.4 months (range, 3-24 months). All fracture united in the one-stage, with mean union time of 5.2 months (range, 3-7 months). According to the Mears and Velyvis system, 10 cases obtained anatomical reduction, 6 were satisfied, and 3 were unsatisfied. According to the Majeed criteria, the results were excellent in 6 cases, good in 10 and fair in 3. After operation, 2 cases sustained poor control of urination caused by sacral nerve injury; 1 case still had hip pain caused by old acetabular fracture, but the symptom could be controlled by non-steroidal anti-inflammatory drugs; 2 cases had sacroiliac joint pain. There was no fixation failure. Conclusion Through the combined approach, osteotomy and fixation of malunion in anterior and posterior rings of pelvis that restores the pelvic ring is an effective method to improve the quality of fracture reduction and rectify limb shortening. Key words: Pelvis; Acetabulum; Fracture fixation, internal; Lumbosacral fixation

Application of 3D printing technology in treatment of acetabular posterior wall fractures

Objective To evaluate the preliminary application of 3D printing technology in the treatment of acetabular posterior wall fractures. Methods A retrospective study was conducted to analyze the 34 patients who had been admitted for acetabular posterior wall fracture between January 2014 to April 2015. They were 18 men and 16 women, from 21 to 65 years of age. According to the Letournel-Judet classification, there were 17 cases of posterior wall fracture, 11 ones of posterior column + posterior wall fracture, and 6 ones of transverse + posterior wall fracture. Of them, 15 used 3D printing technology to fabricate individualized 3D fracture models for preoperative planning, including 7 men and 8 women, with an average age of 45.1±14.2 years. The other 19 cases underwent conventional surgery without aid by 3D printing technology, including 11 men and 8 women, with an average age of 43.7±13.2 years. All the patients were treated by internal fixation through the Kocher-Langenbeck approach with AO mini plate combined with reconstruction plate. The 2 groups were compared in terms of operation time, intraoperative bleeding, intraoperative fluoroscopy frequency, fracture reduction, hip joint function at the last follow-up and postoperative complications. Results All the patients were followed up for an average of 11.1 months (range, from 3 to 16 months) . The operation time for the 3D group (83.2±13.5 min) was significantly shorter than that for the conventional group (96.8±13.1 min) , the intraoperative bleeding (257.3±54.7 mL) and the intraoperative fluoroscopy frequency (2.7±0.8 times) in the 3D group were significantly less than those in the conventional group (327.1±70.4 mL; 3.3±0.9 times) (P 0.05). Conclusion In the treatment of acetabular posterior wall fractures, 3D printing is an effective adjuvant technique which can reduce operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Surgery, computer-assisted; 3D printing technology

Modified subinguinal approach for treatment of acetabular anterior column and wall fractures

Objective To discuss efficacy of modified subinguinal approach for treatment of acetabular anterior column and wall fractures. Methods A clinical retrospective study was performed of 5 patients who had been treated at our department from January 2011 to April 2015 for acetabular anterior column and wall fractures and conformed to follow-ups. They were 3 males and 2 females, aged from 19 to 45 years (mean, 35.6 years) . The duration from injury to surgery averaged 7.6 days (range, from 4 to 10 days) . The subinguinal ligament approach was adopted in 5 cases, through which inguinal ligament was preserved intact after sharp dissection of its insertion at anterior superior iliac spine and medial-upper advancement, advantage of expanded exposure of the first window by Farid sub-ilioinguinal approach was retained, and additional lesions due to iliac osteotomy were avoided. The operation time, intraoperative bleeding, postoperative reduction and time for fracture union were documented. Merle d' Aubigne and Postel scoring system was used to assess hip joint function of affected limb at final follow-ups. Results The operation time ranged from 110 to 150 minutes (mean, 125 minutes) ; intraoperative bleeding ranged from 415 to 550 mL (mean, 450.2 mL) . By Matta's criteria, postoperative reduction was rated as excellent in 4 cases and good in one. The 5 patients were followed up for an average of 32.4 months (range, from 6 to 43 months) . Their fractures united clinically after an average of 4.6 months (range, from 3 to 6 months) . The hip joint function was rated as excellent in 2 and good in 3 by Merle d' Aubigne and Postel scoring system at final follow-ups. Follow-ups observed no serious complications like inguinal hernia, internal fixation failure, myositis ossificans, or avascular necrosis of femoral head. Conclusions As modified subinguinal approach can provide a broad surgical exposure, lead to minimal injury to inguinal ligament, avoid lesions caused by iliac osteotomy, and decrease operation time and bleeding, it may be a better approach for acetabular anterior column and wall fractures. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Surgical approach

Usefulness of Spring Plate for Acetabular Posterior Wall Fracture Including Small Fragment

Purpose: We applied internal fixation using a spring plate against an acetabular posterior wall fracture including small fragments and then evaluated the clinical and radiological results and want to understand the usefulness of the spring plate. Materials and Methods: Fifteen patients in whom fixation was difficult using leg screws or a metal plate because of a small bone fragment, in patients with posterior wall acetabular fractures who presented in our hospital since August of 2011 to March of 2014 were enrolled. The mean age was 42.6 years (range 24-54 years) with relatively young patients, and they were followed-up for at least one year. We analyzed the rate of reduction after surgery using the classification of Matta in radiographs, and the classification of Borrelli in 3-dimensional computed tomography (CT) and clinical results were evaluated using the clinical grading system. Results: There were five cases of anatomical reduction, 9 cases of imperfect reduction, and 1 case of unsatisfactory reduction according to the classification of Matta. Except for one case during the follow-up period, the union of bone was successful without failure of fixation and the clinical results were 6 cases of excellence, 8 cases of good, and 1 case of failure. Articular displacement was also evaluated in postoperative CT scan according to Borrelli’s criteria. The mean of gap and step off was 2.04 mm, 1.3 mm. Conclusion: Use of leg screw fixation and so on in posterior wall fractures including a small fragment of the acetabular rim is not easy. However the method using spring plate fixation enables relatively accurate reduction and fixation for a small fragment and the clinical outcome showed satisfactory results.

Unique simultaneous dual mechanism based bilateral femoral head fracture secondary to posterior dislocation of hip: A rare case report

Hip joint being surrounded by strong ligaments and muscles is considered a stable joint and dislocations are exceptionally rare. Majority of the dislocations are unilateral and are secondary to a high velocity traumatic injury making a bilateral dislocation a rare entity. Due to high velocity injury, femur head and acetabular wall fractures have been associated to dislocations and each of the associated injuries occurs with a different mechanism of injury. In view of its rarity we hereby have reported a unique mechanism based case of bilateral posterior dislocation of hip with bilateral femoral head fracture.

An important factor often ignored in operative treatment of fracture of acetabular posterior wall -- analysis of plate placement

Objective To analyze the optimal position of reconstructive plate in the operative treatment of acetabular posterior wall fractures by comparing 2 plate placements. Methods From May 2004 to January 2014, 58 patients with acetabular posterior wall fracture according to Letournel-Judet classification were treated at our department. They were 46 men and 12 women, aged from 20 to 67 years. The fracture affected the left side in 27 cases and the right side in 31 ones. The time from injury to surgery ranged from 1 to 19 days. Their reduction and fixation were conducted with a 3.5 mm reconstructive plate and lag screws via the Kocher-Langenbeck approach. They were divided into 2 groups according to the positions of the plate and the screws. In group A of 25 cases, screws were placed behind the plate, far from the acetabular rim. In group B of 33 cases, screws were placed ahead of the plate, close to the acetabular rim. The 2 groups were compared in terms of reduction, fracture healing time, complications, and functional recovery. Results The 58 patients were followed up for an average of 2.3 years (range, from 1 to 5 years). According to the modified Matta criteria, anatomic reduction was achieved in all the patients. Fracture healing time averaged 14.8±3.5 weeks in group A and 14.6±3.4 weeks in group B, showing no statistically significant difference(t =0.073, P=0.788). According to the modified Merle d'Aubigne & Postel criteria, the hip function was excellent in 8 cases, good in 11, fair in 4, and poor in 2 in group A, giving an excellent to good rate of 76.0% ; the hip function was excellent in 11 cases, good in 17, fair in 4, and poor in one in group B, giving an excellent to good rate of 84.8%. There was a significant difference between the 2 groups (χ2 = 4.581, P=0.032). The incidence of complications in group A (32.0%, 8/25) was significantly higher than in group B (9.1%, 3/33) (χ2 = 5.926, P= 0.015). Conclusion In treatment of acetabular posterior wall fractures, the pelvic reconstructive plate should be placed as close as possible to the acetabular rim because the plate at this position can provide stronger and more stable fixation. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone plates; Treatment outcome

Marginal impaction in posterior wall fractures of the acetabulum.

The purposes of this study were to describe the CT features of isolated posterior acetabular wall fractures with associated marginal impaction and to discuss the potential therapeutic implications of recognizing this type of fracture. Marginal impaction is an important cause of articular incongruity that adversely affects prognosis. Radiologists should be capable of identifying posterior acetabular wall fracture patterns because they may be the first to suggest diagnoses.

The submuscular sliding plate technique for acetabular posterior wall fractures extending to the acetabular roof

There is extension of the Kocher-Langenbeck approach using trochanteric osteotomy for posterior wall fracture extending to acetabular roof, but it exposes to complications such as nonunion, breakage, and heterotopic ossification. The current study introduces a submuscular sliding plate technique. We retrospectively analyzed 13 patients treated with this technique. It is based on conventional method for posterior wall fracture. After reduction of roof fragment with direct visualization, a pre-contoured plate was passed through a submuscular tunnel under the gluteus medius and minimus. A small split incision was performed on the muscles, and screws were inserted with a triple trocar complex safely under fluoroscopic imaging. All patients had fracture union without complications. X-rays results showed anatomical reduction in 10 cases and imperfect reduction in 3 cases. Our results were satisfactory, particularly without heterotopic ossifications despite no prophylactic regimen of NSAID was applied and no neurological complications, so we believe that this technique is a good option for posterior wall fractures extending to the acetabular roof.